Epidemiology of paediatric pyogenic musculoskeletal infections in a developing country.

Background: Epidemiological data regarding paediatric pyogenic musculoskeletal infections from developing countries of Asia and Africa are sparse and further complicated by the presence of factors like malnutrition, delay in initiating treatment and belief in alternative forms of treatment and under vaccination. The aim of this study is to retrospectively analyse the cases of paediatric pyogenic musculoskeletal infections in a tertiary care centre in India. Methods: It is a retrospective study including patients below 18 years of age who had been diagnosed with any pyogenic musculoskeletal infection. Demographic, clinical, laboratory, and radiological details were collected. Results: A total of 216 children, with a mean age of 12.8 ± 4.9 years (10 days-18 years), were included in the study. The causative organism could be isolated in 98 cases (45.3%). Escherichia coli and methicillin-sensitive Staphylococcus aureus were the most common pathogens isolated in infants and children, respectively. Imipenem and linezolid were the commonest sensitive antibiotics for children up to 10 years and above 10 years, respectively. Linezolid was the antibiotic of choice in culture-negative cases. The majority (78.3%, n = 169) of children underwent a surgical procedure during the stay at the hospital. A higher relapse rate (61%) was noted in culture-negative patients. Conclusion: Improved methods of pathogen detection should be explored to improve the rate of positive cultures. Additional prospective studies with longer patient follow-up and the creation of care protocols are necessary to improve therapeutic decision-making and the prognosis for children with suspected musculoskeletal infection.

Intramedullary Crossed K-wire Fixation for the Hand Fractures is a Useful Treatment Modality: A Prospective Observational Study.

Background: Various modalities of treatment have been used for the management of metacarpal and phalangeal fractures which include K-wire fixation, mini plates, lag screws fixation, intramedullary screw fixation and external fixator application. The aim of this study was to analyse complications and patient-related functional outcomes after antegrade or retrograde crossed intramedullary K-wire fixation of metacarpal and proximal phalangeal fractures. Methods: Thirty-one patients (36-fractures, 16-metacarpals, 20-proximal phalanx) meeting the study criteria were included in this prospective study. Fixation of the fractures was done by use of crossed intramedullary K-wire using the principles of 3-point fixation. Results: The mean preoperative angulation of the fractures noted in this study was 35.8° which was significantly reduced at final follow-up. Union was noted at a mean period of 4.2 ± 6.8 weeks. The mean range of motion at the metacarpophalangeal and proximal interphalangeal joint was 96.4% and 86.3%, respectively as compared to the opposite hand. Stiffness (n = 3, 14.2%) and persistent pain (n = 2, 9.5%) at the joints were the most common complications noted in this study. Conclusion: Crossed percutaneous intramedullary fixation of small bone fractures of the hand is a versatile method with advantages such as cost-effectiveness and lesser operative time when compared to other modalities of fixation. Earlier range of motion (ROM) exercises can be started due to preservation of gliding planes, no surgical wound along with good fracture stability and minimal hardware impingement. How to cite this article: Ahmad S, Gupta T, Ansari S, et al. Intramedullary Crossed K-wire Fixation for the Hand Fractures is a Useful Treatment Modality: A Prospective Observational Study. Strategies Trauma Limb Reconstr 2022;17(2):74-80.

A prospective study on transfer of pronator teres to extensor carpi radialis brevis for forearm and wrist deformity in children with cerebral palsy.

We prospectively evaluated the clinical and functional outcomes of pronator teres to extensor carpi radialis brevis transfer in children with cerebral palsy. Patients were followed-up at 6 months postoperatively, and functionally assessed using the House classification, Manual Ability Classification System (MACS) and Upper Extremity Functional Index (UEFI). Fifteen children with a mean age of 8.1 years underwent tendon transfers. All patients were of Gschwind and Tonkin Grade 2 for pronation deformity; eight patients were of Zancolli's classification Group 1 and seven, Group 2 for wrist flexion deformity. The average gain in active supination was 67°, and wrist extension 15°. An increase of 7.0 in the UEFI score was recorded, although no significant improvement in MACS and House classification was observed. We conclude that the pronator teres to extensor carpi radialis brevis transfer improves upper limb function through effective correction of forearm pronation and wrist flexion deformities.Level of evidence: II.

Functional outcome in giant cell tumor of distal radius treated with excision and fibular arthroplasty: a case series.

INTRODUCTION: Giant cell tumor (GCT) of bone is a locally aggressive benign neoplasm that is associated with a wide spectrum of biological activity ranging from latent benign to highly recurrent and has occasional metastatic potential. It affects the meta-epiphyseal region of long bones of young adults with most common site involved is the distal femur, followed by the distal radius. Plain radiographs and contrast-enhanced magnetic resonance imaging are the imaging modalities widely used followed by definite histopathology for diagnosis. Surgical treatment with curettage is considered optimal for local tumor control. Tumor excision with tumor-free margins is associated with lesser recurrence rates; however, for periarticular lesions this is usually accompanied with a suboptimal functional outcome. METHODS: Eleven eligible patients (all females, mean age 39.2 years) with Campanacci grade III GCT of the distal radius who were treated by en bloc resection and reconstruction with non-vascularized proximal fibular autografts at a single centre between July 2016 and December 2017 were included in the study. The patients had a clinical and radiographic review every month for the first 6 months, then biannually for minimum of 2 years. The functional, oncologic and radiological outcomes of the patients were analyzed and recorded. RESULTS: The mean duration of follow-up was 31.9 months. Bony union was achieved in all cases. The mean VAS score at 6 months was 1.1 (range 0-2). The mean Mayo Wrist score was 66.36 (range 55-80) with mean MSTS score was 21.09 (range 18-24). The average range of motion of the wrist was: 37.3° ± 6.9° of flexion, 47.1° ± 7.5° of extension, 57.3° ± 7.8° of supination and 63.6° ± 6.4° of pronation. The average graft length used was 15.6 cm. The complications noted were lung metastases which developed preoperatively, local site recurrence, wrist joint subluxation, foot drop and wound complication. DISCUSSION AND CONCLUSIONS: The primary aim of treating GCT distal radius is oncologically sound resection with good functional outcome and cosmesis being secondary. Reconstruction with a non-vascularized proximal fibular autograft is a reasonable option after en bloc resection of the distal radius for giant cell tumor of bone having comparable results with other treatment modalities.